2024 AANP EXAM STUDY GUIDE | QUESTIONS AND CORRECT ANSWERS | LATEST UPDATE, Exams of Nursing

Download 2024 AANP EXAM STUDY GUIDE | QUESTIONS AND CORRECT ANSWERS | LATEST UPDATE and more Exams Nursing in PDF only on Docsity! 2024 AANP EXAM STUDY GUIDE | QUESTIONS AND CORRECT ANSWERS | LATEST UPDATE | ALL WHAT YOU NEED IN ONE DOCUMENT By 6 months: no big smalls or joyful expressions 9 months: no back and forth sharing of sounds, smiles or other facial expressions 12 months: lack of response to name, no babbling or baby talk, no back and forth gestures such as pointing, showing, reaching, or waving 16 months: no spoken words 24 months: no meaningful two word phrases that don't involve imitating or repeating. ---- -CORRECT ANSWER--------------Developmental red flags infants to 2 years: rear facing until 2 y.o. or until highest ht or wt allow by manufacturer Toddler/preschoolers: forward facing seats with harnesses up to highest ht and wt allow by manufacturer School aged: booster until 4 ft 9 inches and between 8 and 12 y.o. Older children: seat belts and rear seats until 13 y.o. -----CORRECT ANSWER------------ --Car seat use scarletina form or sandpaper like rash with exudative pharyngitis, fever, HA, tender, localized ant cervical lymphadenopathy. Rash usually erupts on day 2 of pharyngitis and peels a few days later. PCN or macrolide if allergy. -----CORRECT ANSWER--------- -----scarlet fever Discrete rosy pink macular or maculopapular rash lasting hours to 3 days that follows a 3-7 day period of fever, often quite high. usually in kids less than 2. supportive tx. ----- CORRECT ANSWER--------------Roseola fever, sore throat, malaise, nasal discharge, diffuse maculopapular rash lasting about 3 days, post cervical and postauricular lymphadenopathy 5-10 days prior to onset of rash. arthralgia in 25%. incubation period of 14-21 days with disease transmissable for 1 week prior to onset of rash to weeks after rash appears. generally self limiting. danger to fetus with 1st trimester exposure. -----CORRECT ANSWER--------------Rubella acute with fever, nasal, discharge, cough, general lymphadenopathy, conjunctivits, photophobia, koplik spots (white spots with blue rings held within red spots in oral mucosa), mild pharyngitis without exudate. maculopapular rash 3-4 days after onset of sxs. incubation period of 14-21 days with disease transmissable for 1 week prior to onset of rash to weeks after rash appears. CNS and resp tract complications common. Risk of neruo impairment or death. supportive tx. -----CORRECT ANSWER-------------- Measles - rubeola virus fever, shaggy purple white exudative pharyngitis, malaise, diffuse lymphadenopathy, hepatic and splenic tenderness, monospot test. If given amox or ampicillin, rash will occur. Avoid contact sports for more than one month because of risk of splenic rupture. -----CORRECT ANSWER--------------Mono MR=Mitral regurg P= physiologic AS=Aortic Stenosis S=Systolic MVP=Mitral Valve Prolapse -----CORRECT ANSWER--------------Systolic Murmurs MS = Mitral Stenosis AR=Aortic regurg D=Diastolic -----CORRECT ANSWER--------------Diastolic Murmurs use bell and diaphragm - aortic stenosis -----CORRECT ANSWER--------------Harsh Murmur low so heard best with bell - mitral stenosis -----CORRECT ANSWER--------------Rumble Hemic murmur -----CORRECT ANSWER--------------Heart murmur seen in b12 deficiency S. pneumoniae -----CORRECT ANSWER--------------Most common pathogen in CAP, ABRS, AOM H. influenzae, more than 30% now pcn resistant via beta lactamase production ----- CORRECT ANSWER--------------Common pathogen in ABRS, AOM, CAP particularly with recurrent infections and tobacco use Augmentin 500/125 TID or 875/125 BID -----CORRECT ANSWER--------------First line treatment for Acute Bacterial Rhinosinusitis Augmentin 2000/125 BID or doxy 100 mg BID or 200 mg QD -----CORRECT ANSWER- -------------Second line treatment for Acute Bacterial Rhinosinusitis Doxy, Levofloxacin, Moxifloxacin -----CORRECT ANSWER--------------Treatment for ABRS if allergic to PCN, Cephalosporins Doxy, levofloxacin, moxifloxacin -----CORRECT ANSWER--------------Treatment for ABRS if antibiotic resistance of failed initial therapy slowly progressive hearing loss that is symmetric and high frequency -----CORRECT ANSWER--------------Presbycusis Intranasal corticosteriods like Flonase, Nasonex, Nasacort, Omnaris. Side effects are that nasal irritation and bleeding may occur. Optimal efficacy may take 1-2 weeks. ----- CORRECT ANSWER--------------1st line controller therapy in allergic rhinitis Nasal antihistamines, esp if there is nasal congestion. sedation could occur. Drugs like astelin, Astepro, and patanase -----CORRECT ANSWER--------------1st line rescue treatment in allergic rhinitis significant potential to cause sedation and anticholinergic effects so not a first line therapy. Ex. benadryl, chlor trimeton, dimetapp, vistaril. -----CORRECT ANSWER--------- -----1st generation oral antihistamines These are preferred over because no anticholinergic effects but not as helpful with nasal congestion. Ex. claritin, clarinex, zyrtec, allergra -----CORRECT ANSWER---------- ----2nd generation oral antihistamines alpha adrenergic agonist so vasoconstrictive. Take caution with the elderly, young children, HTN, bladder neck obstruction, glaucoma, and hyperthyroidism. Ex. sudafed -- ---CORRECT ANSWER--------------Oral decongestants Alpha adrenergic agonist so vasoconstrictive. Can cause rebound congestion/medicamentosa so limit use to 5-7 days. -----CORRECT ANSWER------------- -Nasal decongestants reduce runny nose because of drying action. No effect on other nasal symptoms. Dryness can occur. Ex.. Atrovent -----CORRECT ANSWER--------------Intranasal anticholinergics deeply cupped optic disc because of increase intraocular pressure than pushes the optic disc backwards., acute, painful -----CORRECT ANSWER--------------Found on fundoscopic exam of person with angle-closure glaucoma screening test for macular problems. -----CORRECT ANSWER--------------Amsler grid measurement of intraoccular pressure, screen for glaucoma -----CORRECT ANSWER-- ------------Tonometry Hardening of the lens, close vision problems, adults over 45 -----CORRECT ANSWER-- ------------Presbyopia lens clouding, progressive vision dimming, distance vision problems, close vision usually retained and often improves. Risk factors are tobacco use, poor nutrition, sun exposure, systemic corticosteriod therapy. Potentially correctable with surgery. ----- CORRECT ANSWER--------------Senile cataracts Painless, gradual onset of increased intraocular pressure leading to optic atrophy. Causes a loss of peripheral vision if not treated. Avoidable with appropriate and ongoing intervention. more than 80% of all glaucoma. Treat with topical miotics, beta blockers, or surgery -----CORRECT ANSWER--------------Open-angle glaucoma sudden increases in intraocular pressure. Usually unilateral, painful, red eye, halos around lights, eyeball firm when compare to other. Immediate referral to opthmalogy ---- -CORRECT ANSWER--------------Angle closure glaucoma thickening sclerotic changes in retinal basement membrane complex. Causes painless changes in vision including distortion of central vision. On fundo exam will see drusen (soft yellow deposits in macular region). Risk factors are tobacco use, sun exposure. No treatment available for dry form. Laser treatment or intraviteal injection of antivascular growth factor for wet form -----CORRECT ANSWER--------------Macular degeneration Primary: opthalmic with FQ ocular solution. Secondary: opthalmic treatment with polymixin B with trimetroprim solution or with azithromycin 1%. -----CORRECT ANSWER--------------Treatment of suppurative (non gonococcal or chlamydial infection (s. aureas, s. pneumo, H. influ) best choice in antimicrobial therapy for a skin and soft tissue infection likely caused by MRSA. -----CORRECT ANSWER--------------Bactrim Central blistering with surrounding gray to purple discoloration at bite site. Surrounded by ring of blanched skin surrounded by large area of redness. -----CORRECT ANSWER--------------Brown Recluse spider bites normal level is 0.4-4.0. Reflects anterior pituitary lobe's ability to detect amount of circulating free thyroxine. -----CORRECT ANSWER--------------TSH Normal level is 10-27. Unbound metabolically active portion of thyroxine. -----CORRECT ANSWER--------------Free T4 Normal level is 4.5-12.0. Reflects the total fo protein bound and free thyroxine. ----- CORRECT ANSWER--------------Total T4 Normal level is 3.5 to 7.7. unbound metabolically active portion of triiodothyronine (T3). Is about four times more metabolically active. -----CORRECT ANSWER--------------Free T3 Noraml is 95-190. Reflects the total of the protein bound and free triiodothyronine. ----- CORRECT ANSWER--------------Total T3 low free T4 and high TSH. Give synthroid by dosing by weight, using ideal body wt in obesity, actual in underweight. 1.6 mcg/kg/day in adults, 4.0 mcg/kg/day in kids, 1.0 mcg/kg/day in elderly. 50% increase during pregnancy so send to high risk OB. Increase dose by 33% or more as soon as pregnancy is confirmed. Check TSH every 6- 8 weeks or 8-12 weeks. -----CORRECT ANSWER--------------Untreated hypothyroidism High free T4 and low TSH. treat with beta adrenergic antagonist with B1,B2 blockage such as propranolol to counteract tachycardia and tremor. Use PTU or tapazole. Radiactive iodine tx. -----CORRECT ANSWER--------------Untreated hyperthyroidism High TSH, normal free T4. Recommend tx of people with TSH more than 5 if the patient has goiter or if thyroid antibodies present. Presence of sxs compatible iwth hypothyroidism, infertility, pregnancy, or imminent pregnancy would favor tx. ----- CORRECT ANSWER--------------Subclinical hypothyroidism Risk of malignancy if 5%. Hx of head or neck irradiation, localized pain, dysphonia, hemoptysis, regional lymphadenopathy, or a hard, fixed mass should raise suspicion. Initial testing with TSH measurement. A hot nodule has low risk of malignancy. Fine needle aspiration advised regardess of TSH results. -----CORRECT ANSWER------------- -Evaluation of thyroid nodule Sudden, abrupt, "thunderclap" headache is suggestive of subarachnoid hemorrhage. Headache with exertion, sex, coughing and sneezing is suggestive of increased cranial pressure. -----CORRECT ANSWER--------------Red flag onset of headache last 30 minutes to 7 days but usually 1-24 hours; pressing, nonpulsatile pain, mild to moderate intensity, bilateral, Can have 1 of the following characteristics: nausea, photophobia, phonophobia. -----CORRECT ANSWER--------------Tension type headache last 4 to 72 hours, unilateral, moderate to severe with pulsating, aggravated by normal activity, nausea, ,vomiting, photophobia, phonophobia, -----CORRECT ANSWER--------- -----Migraine without aura focal dysfunction of cerebral cortex of brain stem causes more than 1 aura symptom; develop over 4 mins. Sxs include feeling of dread or anxiety, unusual fatigue, nervousness, GI upset, visual or olfactory alteration. Should not last more than 1 hour. - ----CORRECT ANSWER--------------Migraine with aura triptans, ergot deriviatives. Caution about pregnancy, CVD, uncontrolled HTN due to vascular effects. -----CORRECT ANSWER--------------Migraine specific meds Beta blockers like propranolol, CCBs, TCAs, antieleptics like gabapentin, depakote, topamax), lithium for cluster. Need these if use any product more than 3 times a week, have more than 2 migraines a month with disabling sxs more than 3 days, poor sx relief from other txs, present of other conditions like HTN, hemiplegic or basilar migraines. ---- -CORRECT ANSWER--------------Prophylactic "controller meds" for HA hemorrhage of days to weeks duration, AV malformation, carcinomatous meningitis, tumor, posterior fossa lesions -----CORRECT ANSWER--------------Use MRIs for acute or chronic hemorrhage, edema, atrophy, ventricular size -----CORRECT ANSWER--------------CT without contrast tumor, abscess -----CORRECT ANSWER--------------CT with contrast Eliminate offending meds: smooth muscle relaxers like CCBs, theophylline, nitrates, estrogen, progestin. Treat with H2RAs like pepcid, zantac. These are considered first line acid suppression therapy. Proton pump inhibitors are better than H2RAs at suppressing post-prandial acid surge. Protracted use association with B12, Ca, and Fe malabsorption. Alarm findings may warrant endoscopy: dysphagia, bleeding, wt loss, odynophagia ----- CORRECT ANSWER--------------GERD dyspepsia, chest pain, postprandial fullness, chronic hoarseness, sore throat, cough, wheezing. -----CORRECT ANSWER--------------GERD presentation positive when slight lateral pressure on the skin results in epidermal exfoliation. ----- CORRECT ANSWER--------------Nikolsky's Sign sharp, localized pain, worse with deep breath, movement or cough. Audible pleural friction rub. "fresh snow" sound. -----CORRECT ANSWER--------------Pleural Inflammation Anticholinergic bronchodilator, inhaled beta 2 agonist -----CORRECT ANSWER----------- ---Acute bronchitis by virus macrolide or tetracycline -----CORRECT ANSWER--------------Acute bronchitis by M. pneumo, C. pneumo, pertussis recurrent cough, wheeze, SOB, chest tightness. Sxs worse at night, with exercise, viral resp infections, aeroallergans, pulmonary irritants. Airflow obstruction is at least partially reversible. -----CORRECT ANSWER--------------Asthma ICS are preferred for persistant asthma (flovent, pulmicort, QVAR) ICS/LABA are preferred for moderate or severe asthma (Symbicort, Advair). LTRA or LTM: most often used in conjunction with ICS: Singulair -----CORRECT ANSWER--------------Asthma controller meds Hyperresonance, decreased tactile fremitus, wheeze (exp first and insp later), low diaphragms, increased AP diameter. -----CORRECT ANSWER--------------Air trapping in asthma or COPD Considered in any pt with persistant dyspnea, chronic cough, history of exposure to smoke, pollution. The presence of bronchdilator FEV1 less than 0.70 confirms persistant airflow obstruction. -----CORRECT ANSWER--------------Clinical dx of COPD Short acting beta 2 agonist and/or anticholinergic as needed. Consider a LABA. If baseline FEV1 less than 50% predicted, add systemic corticosteroid for 10 days. Use noninvasive positive pressure ventilation in more severe exacerbations. Mild to moderate exacerbation: ABX usually not indicated but if given: Amox, Bactrim, Doxy Moderate to severe: Augmentin, microlides, FQ -----CORRECT ANSWER-------------- Treatment of COPD exacerbation Insulin secretagogue, may be less effective after 5 years -----CORRECT ANSWER------- -------Sulfonylurea (glipizide, glyburide) Reduces hepatic glucose production and intestinal glucose absorption. It is an insulin sensitizer. Monitor kidney function. Avoid in heart failure. Rare risk of lactic acidosis. Omit day of surgery and 48 hours after and reinitiate once baseline renal function obtained. Can be use preventatively. -----CORRECT ANSWER--------------Biguanide (Metformin) Insuilin sensitizer via receptors found in muscle, adipose, tissues. Edema risk. TZD can exacerbate heart failure. Proglitazone use for more than 1 year can cause bladder cancer. -----CORRECT ANSWER--------------Thiazolidinedione (TZD, glitazones) Stimulates insulin production in response to increase in plasma glucose. Slows gastric emptying. Major SE is N/V. Contraindicated in gastroparesis. Exenatide can cause pancreatits. -----CORRECT ANSWER--------------GLP 1 agonist (Byetta, Victoza) Use in combination with metformin or TZD. Watch for pancreatitis. -----CORRECT ANSWER--------------DPP4 Inhibitor (gliptins) Delays intestinal carb absorption. Taken with first bite of a meal. Does not enhance insulin secretion or sensitivity. Flatulaence is a problem. Avoid in IBD, impaired renal function. -----CORRECT ANSWER--------------Alpha glucosidase inhibitors (Acarbose) At time of dx if gluose betwee 250-300 When acutely ill because glucose should be kept between 140-180 When more than 2 agents at optimized use are inadequate. -----CORRECT ANSWER--- -----------When to initiate insulin use Onset: 15-30 minutes Peak: 30 minutes to 2.5 hours Duration: 3-6.5 hours -----CORRECT ANSWER--------------Short Acting Insulin/ rapid(Lispro - humalog) Onset: 10-20 minutes Peak: 1-3 hours Duration: 3-5 hours -----CORRECT ANSWER--------------Short acting, rapid (Aspart - Novolog) Onset: 10-15 minutes Peak: 1-1.5 hours Duration: 3-5 hours -----CORRECT ANSWER--------------Short Acting /Rapid (Apidra) Onset: 30 mins to 1 hour Peak" 2-3 hours Duration: 4-6 hours I -----CORRECT ANSWER--------------Short Acting (regular, Humulin R, Novolin R) Onset: 1-2 hour Peak: 6-14 Duration: 16-24 hours -----CORRECT ANSWER--------------Intermediate acting (Humulin N or Novolin N) Aspirin, ACEI, or ARB Beta blocker or alpha beta blocker Statin - check renal function, GFR, CR, microalbuminuria, fasting lipid profile annually Foot exam with every visit -----CORRECT ANSWER--------------DM additional Care irritative voiding sx, occassional micropurulent sx. cervicitis common in women. Large number of WBCs. Both sexes sometimes without sxs. Treat with Azithromycin ----- CORRECT ANSWER--------------Nongonococcal urethritis and cervicitis irritative voiding sx, occassional micropurulent sx. cervicitis common in women. Large number of WBCs. Both sexes sometimes without sxs. Tx with Rocephin IM plus azithromycin (1 dose) or doxy x 7 days -----CORRECT ANSWER--------------Gonococcal urethritis and vagintitis dysuria, itching, irritation, pain with sex, yellow-green vaginal discharge, cervical petechial hemorrhages (strawberry spots), sometimes no sxs. Alkaline pH. Tx with metronidazole as one time dose. -----CORRECT ANSWER--------------Trich Primary stage: chancre (firm, round, painless with clean base and indurated margins accompanied by localized lymphadenopathy, last about 3 weeks and resolves without therapy. Secondary stage: nonpruritic skin rash, palms and soles, as well as mucus membrane lesions. Fever, lymphadenopathy, sore throat, patchy hair loss, HA, wt loss, muscle aches, fatigue. Latent stage: neuro issues. Tx with injectible PCN or doxy if allergic. -----CORRECT ANSWER--------------Syphilis May go unrecognized. Tx with podofilox, liquid nitrogen, cryoprobe, tricholoroacetic, acid, podophyllin resin, surgical remove, imiquiod. Trichloroacetic acid and cryoprobe preferred during pregnancy. -----CORRECT ANSWER--------------Genital warts (HPV 6/11) Irritative voiding, fever, abdominal pain, cervical motion tenderness, vaginal discharge,. Can cause infertility, tubal scarring. Tx: rocephin IM plus doxy for 14 days with or without metronidazole.for 14 days. -----CORRECT ANSWER--------------Pelvic Inflammatory Disease Primary: if resistance to Bactrim is low and no allergy, give bactrim twice a day for 3 days. If resistance high or if there is an allergy, give nitrofurantoin for 5 days or fosfomycin for 1 dose. Alternative: Can give FQ for 3 days or Aumentin 875/125 for 5-7 days or an oral cephalosporin. -----CORRECT ANSWER--------------UTI in nonpregnant women usually women 18-40 with fever greater than 102 with CVA tenderness. Primary: Cipro 500 mg bid for 7 days, levaquin for 5 days. -----CORRECT ANSWER----- ---------Uncomplicated pyelonephritis Treat with a cephalosporin -----CORRECT ANSWER--------------G6PD deficiency Upper reproductive tract infection, usually younger than 35. Present with irritative voiding, painful swelling or epididymis and scrotum. Possible infertility after. Treat with Rocephin plus doxy, advise scrotal elevation. Plehn's sign - relief of discomfort with scrotal elevation. -----CORRECT ANSWER--------------Epididymitis Age greater than 35 or insertive partner in anal intercourse. Present with irritative voiding, painful swelling or epididymis and scrotum. Possible infertility after. Tx with Cipro 550 or levo 750 for 10-14 days. -----CORRECT ANSWER--------------Epidymitis or epididymoorchitis irritative voiding, suprapubic, perineal pain, fever, tender, boggy prostate, leukocytosis. Treat with rocephin IM plus doxy for 10 days -----CORRECT ANSWER--------------Acute bacterial prostatis less than 35 y.o. irritative voiding, suprapubic, perineal pain, fever, tender, boggy prostate, leukocytosis. Treat with cipro or ofloxacin for 14 days. -----CORRECT ANSWER--------------Acute bacterial prostatis older than 35. irritative voiding, dull, poorly localized pain, suprapubic, perineal pain. Tx with Cipro BID for 4 weeks or levo qd for 6 weeks. Can treat with Bactrim twice a day for 1-3 months. If doesn't work, consider prostatic stones. -----CORRECT ANSWER--------------Chronic bacterial prostatis DRUGS:Anticholingergics like TCAs, 1st gen antihistamines, neuroleptics, atypical psychotics, opioids, benzos, alcohol EMOTIONAL: mood disorders, loss. ELECTROLYTE IMBALANCES: esp hyponatremia, LOW PO2, LACK OF DRUGS: withdrawal from alcohol, INFECTION: UTI, CAP, Retention of urine or feces. Reduced sensory input, seizures, undernutrition, metabolic, myocardial problems, subdural hematoma. Fractures, infections, and medications are most common causes. ----- CORRECT ANSWER--------------Delirium etiology back pain with standing, leg numbness, pain improvement iwth flexed forward position. For sxs lasting longer than 1 month, consider MRI, EMG. Do PT, NSAIDS, epidural steroid injection, maybe surgery. -----CORRECT ANSWER--------------Lumbar spinal stenosis sx longer than 5 minutes, aura or prodrome, usually no injury, may have urinary incontinence, elevated CK, postictal state. -----CORRECT ANSWER--------------Seizure less than 5 minutes, no warning, injury, no urinary incontinence, Normal CK, No disorientation after. -----CORRECT ANSWER--------------Syncope sense of disturbed relationship to space but surroundings are not moving. "feels lightheaded" Treat underlying cause. -----CORRECT ANSWER--------------Dizziness Surroundings are moving, sensation of motion with eyes closed, "room is spinning" Usually an inner ear disturbance, treat cause. -----CORRECT ANSWER-------------- Vertigo relatively rapid, can usually report correct time, date, location. Notices or worries about memory problem, can report nature of memory difficulty, has trouble with concentration. Usually slow when compared to baseline but normal. -----CORRECT ANSWER------------ --Depression in the elder walks backwards, hops on one foot, copies circle, gives first and last name. ----- CORRECT ANSWER--------------30 months holds crayons with fingers, walks down stairs with alternating steps, rides tricycle, copies circles. Dresses with supervision. -----CORRECT ANSWER--------------36 months responds to command to place object in, on or under a table, draws circle when one is shown, takes off jacket and shoes, washes and dries face, cooperative play, knows gender. -----CORRECT ANSWER--------------3-4 years runs and turns while maintaining balance, stands on 1 foot for at least 10 seconds, counts to 4, draws a person without a torso, copies cross by imitation, buttons clothes, dresses self except tying shoes, can play without adult input for about 30 minutes, verbalizes activities to do when cold, hungry, tired. 6-8 word sentences, names 4 colors, counts 10 objects correctly. -----CORRECT ANSWER--------------4-5 years catches ball, knows age, knows right hand from left hand, draws person with 6-8 parts including torso, able to complete simple chores, sense of gender, identifies best friend, likes teacher. -----CORRECT ANSWER--------------5-6 years copies triangle, draws person with at least 12 parts, prints name, reads multiple single syllable words, counts to 30 and beyond, ties shoe laces, plays well with peers, no big behavior problems at school, names career -----CORRECT ANSWER--------------6-7 years copies diamond, able to read simple sentences, draws person with at least 16 parts, ties shoes, knows days of the week. -----CORRECT ANSWER--------------7-8 years able to add, subtract, borrow, carry, teamwork, able to give response to a question such as what to do if an object is accidentally broken. -----CORRECT ANSWER--------------8-9 years old coos in response to voice -----CORRECT ANSWER--------------Language 1-6 months babbles -----CORRECT ANSWER--------------lang 6-9 months imitates sounds, nonspecific mama, dada -----CORRECT ANSWER--------------lang 10- 11 months specific mama, papa, 2-3 syllable words imitated -----CORRECT ANSWER-------------- lang 12 months 4-7 words, jargon, less than 20% of speech understood by strangers -----CORRECT ANSWER--------------lang 13-15 months extensive jargon, 20-25% of speech understood by strangers -----CORRECT ANSWER- -------------lang 16-18 months 20 words, 50% of speech understood by strangers -----CORRECT ANSWER-------------- lang 19-21 months more than 50 words, 2 word phrases, less jargon, 60-70% of speech understood ----- CORRECT ANSWER--------------lang 22-24 months more than 400 words, 2-3 word phrases, uses pronouns, 75% of speech understood ---- -CORRECT ANSWER--------------lang 2-2.5 yrs 3-6 word sentences, ask questions, tells stories, almost all speech understood ----- CORRECT ANSWER--------------3-4 years 6-8 word sentences, names 4 colors, counts 10 objects correctly -----CORRECT ANSWER--------------4-5 years P - 120-160 BP greater than 60 systolic 40-60 breaths a minute -----CORRECT ANSWER--------------Neonatal Vital signs 100-140 pulse 70-95 systolic 25-50 breaths a minute -----CORRECT ANSWER--------------Infant vital signs 80-100 beats 80-110 systolic 15-30 breaths a minute -----CORRECT ANSWER--------------Child up to 8 vitals occurs at 7-8 months. -----CORRECT ANSWER--------------Separation anxiety eye drops at birth prevent this. -----CORRECT ANSWER--------------Gonococcal conjunctivits can start this at 18-24 months, 1 minute for every year of life -----CORRECT ANSWER-- ------------Time out done at 18 and 24 months of age -----CORRECT ANSWER--------------Autism screening Interacts with "G" herbs - garlic, ginger, ginkgo, ginseng D/C 7 days before surgery Aortic regurgitation presentation ------------------------------Long asymptomatic period followed by exercise intolerance then dyspnea at rest. The left ventricle fails unless the aortic valve is replaced AV nicking is most commonly seen? ------------------------------Retinal exam of patients with hypertension Carotid artery bruits can indicate? ------------------------------Generalized atherosclerosis The USPSTF recommends a 1-time abdominal aortic aneurysm screening with ultrasonography is done in men ------------------------------Age 65 to 75 who have ever smoked Hypertension is the most common cause of? ------------------------------Hemorrhagic stroke Patients with acute coronary syndrome typically have? ------------------------------Plaque erosion caused by accumulation of hyaluronan and neutrophils The ductus arteriosus is a blood vessel that connects? ------------------------------The aorta and the pulmonary artery in fetus so that blood flow skips the lungs In patients with ductus arteriosus, the murmur is best heard where? -------------------------- ----At the left clavicle and is both systolic and diastolic Cardiovascular: Diabetics, females and elderly The tricuspid valve separates what? ------------------------------The right atrium and right ventricle Pulmonic stenosis ------------------------------A mid to late systolic murmur How many licks does it take to get to the Tootsie Roll center of a Tootsie Pop? ------------ ------------------No idea. Aortic regurgitation and mitral valve stenosis are? ------------------------------Diastole only murmurs EKG shows ST elevation, T wave changes (such as inversion), ST depressional and Q waves during episodes of angina. ------------------------------Diastole is the minimum arterial pressure exerted during relaxation and dilation of the ventricle. The 4 heart defects of Tetralogy of Fallot are? ------------------------------- Ventricular Septal Defect - Right Ventricular Hypertrophy - Overriding Aorta - Pulmonary Stenosis Audible S3 in an older adult patient is usually a sign of? ------------------------------Left ventricular hypertrophy from heart failure or cardiomyopathy Atherosclerotic peripheral arterial disease presents with symptomatic limb ischernia upon exertion. ------------------------------Mitral regurgitation is a harsh murmur heard loudest at the apex with radiation toward the left axilla. A widened pulse pressure greater than or equal to 60 in an older adult is a risk factor for? ------------------------------Cardiovascular disease, stroke, or renal disease The atrium forcefully contracting against a stiffened ventricle causes S4. -------------------- ----------Pericarditis often causes sharp chest pain. In coarctation of the aorta, blood pressure is higher in the arms than in the legs due to? ------------------------------Narrowing in the aorta. It is common to hear a split S2 heart sound over the pulmonic area of the heart with inspiration. As long as it disappears with expiration, with no other abnormal symptoms, this is a normal finding. ------------------------------Go Brandy! Go Brandy! Go Brandy GO! Common side effects of NSAIDs are? ------------------------------- Renal impairment - Acute renal failure - Gastritis Oral Iron should be taken on empty stomach with something acidic and high in calcium such as orange juice. ------------------------------Skin manifestations of a Penicillin allergy is hives. Headache, nausea, insomnia, restlessness and agitation are symptoms that a patient may experience when they are started on SSRI but these symptoms usually resolve in 2 weeks. ------------------------------ACEI induced cough usually begins around 2 weeks after starting medication The drug of choice for male patients with a UTI is? ------------------------------Bactrim for 7- 10 days If no response to SSRis another antidepressant can be tried in 8-12 weeks. ---------------- --------------NSAIDs should be used cautiously in patients with hypertension because they cause sodium retention and increase blood pressure. The most common cause of pneumonia in all ages is? ------------------------------Strep pneumo Most common cause of croup is? ------------------------------Parainfluenza virus An incentive spirometer measures? ------------------------------Peak expiratory flow or the flow of air coming in and out of the lungs in one inhalation and one exhalation Varicella Zoster (chickenpox) presents as pruritic papules, macules and vesicles in various stages of healing and is transmitted via the respiratory tract. -------------------------- ----Fifth disease also known as parvovirus or slapped cheek disease is spread via respiratory droplets. Signs and symptoms of croup are? ------------------------------- Hoarseness - Cough - Inspiratory stridor - Respiratory distress due to narrowing of the larynx Vesicular breath sounds (quiet and wispy) are heard over the periphery of the lung fields. ------------------------------Bronchovesicular breath sounds are softer than bronchial sounds but have a tubular quality. Stridor indicates? ------------------------------A partial or complete obstruction of the larynx and is best beard at the neck Tracheobronchitis ------------------------------An acute viral illness that presents with a burning retrostemal discomfort and a dry cough First line treatment for uncomplicated pneumonia? ------------------------------Amoxicillin Most common cause of atypical pneumonia in adults ------------------------------ Mycoplasma pneumoniae First line treatment of atypical pneumonia? ------------------------------Macrolides Emphysema is characterized by? ------------------------------Hyperinflation of the lungs that causes a barrel-shaped chest, pursed-lip breathing, and dyspnea when at rest Infiltrates on an x-ray indicate? ------------------------------Bacterial infection such as pneumonia Eczema is also known as ------------------------------Atopic dermatitis Fifth disease ------------------------------Maculopapular rash in lace-like pattern that blanches easily and may be accompanied by joint aches Tinea cruris is the medical term for? ------------------------------Jock itch. Affects the inner thigh but never the penis or scrotum. Tinea cruris is a fungal infection and should be treated with ------------------------------OTC antifungal cream Teach males to dry after swimming and to not stay in wet bathing suit to avoid contracting tinea cruris. ------------------------------Got nothing for this side.....you're just wasting your time here. Tinea Corporis is the medical term for? ------------------------------Ringworm Scabies is treated with ------------------------------Permethrin and good hygiene Antivirals should be started on a patient with shingles within ------------------------------72 hours of the onset of symptoms Roseola is a viral exanthem characterized by ------------------------------High fever for three days then abrupt stopping of the fever and a maculopapular rash that blanches, also known as exanthem subitem Something about a cow and beef jerkey ------------------------------Because you make the most awesome jokes!! Rhinophyma ------------------------------A skin disorder that causes the nose to enlarge and become red, bumpy and bulbous Poison ivy is not contagious, it can only be transmitted through direct contact with oils from the plant itself. ------------------------------Actinic Keratosis is a precursor to squamous cell carcinoma. Two subsets of impetigo are ------------------------------Bullous (fluid filled) or nonbullous (honey crusted) Seborrheic dermatitis ------------------------------Eczema of the scalp Erythema multiforme ------------------------------Target shaped skin lesions that result from a hypersensitivity reaction to infections and drugs results in hypoglycemia in the early morning (2 a.m. to 3 a.m.). The body compensates by secreting glucagon (from the liver) and epinephrine, which results in high fasting blood glucose levels in the morning. ------------------------------THat one was long, it's getting it's own card. Go ahead and soak that up.... Diagnose Somogyi effect by checking blood glucose at 3am for 1 to 2 weeks. ------------- -----------------Treatment Somogyi effect by eating bedtime snack or decreasing evening/bedtime insulin. The classic triad of symptoms of Ménière's disease ------------------------------- Episodic vertigo - Tinnitus - Sensorineural hearing loss (low frequency) Patients with a thyroid nodule complain of ------------------------------- Hoarseness - Problems swallowing - Dysphagia - Dyspnea or cough Female athlete triad ------------------------------Combination of disordered eating, amenorrhea and osteoporosis Holy cow are these ever going to end? ------------------------------Holy cows are also where Swiss cheese comes from. Overflow incontinence is the only type of incontinence that would not benefit from pelvic floor therapy. ------------------------------Endometriosis is the most common cause of secondary dysmenorrhea. Symptoms of endometriosis include ------------------------------- Spotting - Cervical stenosis/displacement- N - Nodular/tender uterosacral ligaments Athletic amenorrhea increases risk of developing osteoporosis. ------------------------------ Danazol is an androgen used to treat endometriosis and fibrocystic breast disease. Androgen medication side effects ------------------------------- Edema - Hirsutism - Hair loss - Vocal changes The Mirena (Levonorgestrel) IUD stays in for 5 years ------------------------------ Unprotected sexual intercourse in the most common reason for persistent gonorrhea infections. Epididymitis with orchitis is commonly related to genitourinary infection. --------------------- ---------Mycoplasma genitalium is most commonly associated with urethritis in men. The luteal phase (Day 14 to 28) of the menstrual cycle is characterized by a decrease in LH and FSH, the ruptured follicle closes after an egg has been released and forms the corpus luteum (which produces progesterone). Estrogen and progesterone remain high and cause the lining of the uterus to thicken in preparation for fertilization. ------------------ ------------That one sounded complicated! The bacteria that causes syphilis ------------------------------Treponema pallidum The bacteria that causes chancroid ------------------------------Haemophilus ducervi The STI, mycoplasma genitalium is unique because it lacks a cell wall and has a terminal tip-like structure that allows it to attach and enter other cells. ------------------------ ------PID is most commonly caused by chlamydia and gonorrhea. An immature female gamete is ------------------------------Oocyte Fused ovum and sperm once fertilization has occurred is known as --------------------------- ---A zygote Tunica vaginalis ------------------------------The fascia layer of the male anatomy that the anterior 2/3s of the testicles reside in The follicular phase (Day 1 to 14) of the menstrual cycle is characterized by ---------------- --------------FSH and LH increase which stimulates the production of estrogen Phimosis ------------------------------The tightening of the foreskin over the glans that prevents retraction Paraphimosis ------------------------------When you can retract the foreskin, but you can't pull it back up 😲 Ovulatory phase of the menstrual cycle begins with a surge in LH and FSH. ---------------- --------------HIV causes a destruction of the CD4 T cells resulting in eventual immune suppression. The medical term for crabs is ------------------------------Pthirus pubis Petechiae noted on the cervix (strawberry cervix) is a sign of trichomoniasis --------------- ---------------That would be the end of this section! But plenty more to go! Women with BMI less than 18.5 should gain _____________ in pregnancy ----------------- -------------28-40lbs Women with BMI 18.5-24.9 should gain _____________ in pregnancy ----------------------- -------25-35lbs Women with BMI 25-29.9 should gain _____________ in pregnancy ------------------------- -----15-25lbs Women with BMI over 30 should gain _____________ in pregnancy ------------------------- -----11-20lbs Presence of an adnexal mass with tenderness during a vaginal exam of a pregnant woman is consistent of an ectopic pregnancy. ------------------------------HCG doubles every 48 hours during the first 12 weeks in a normal pregnancy Sudden onset of vaginal bleeding associated with painful uterine contractions during pregnancy can be an indication of ------------------------------Abruptio Placentae Painless vaginal bleeding during pregnancy that is worsened by intercourse can indicate ------------------------------Placenta Previa Amniocentesis is done at 15-20 weeks to test for ------------------------------Genetic abnormalities HCG that does not double but increases slowly can indicate ------------------------------ Ectopic HCG that starts decreasing rapidly and cervix is dilated is ------------------------------An inevitable abortion Encopresis ------------------------------Stool incontinence after age of being toilet trained Barlow and Ortolani ------------------------------Test used to diagnose hip dysplasia Viral Pneumonia is the most common type of pneumonia in children age 6 months to 5 years. ------------------------------Acute lymphocytic leukemia often presents as pain in children. Viral Pneumonia is the most common type of pneumonia in ------------------------------ Children age 6 months to 5 years MMR and Varicella immunizations should be given ------------------------------On the same day or at least one month apart Book Burning ------------------------------What we will be doing on March 30th! First sign of sexual maturation in a male is ------------------------------Increase in testicular size (tanner stage 2) Most common cause of acute pharyngitis in children is ------------------------------ Respiratory viruses An acute febrile illness of early childhood characterized by vasculitis of the medium sized arteries, most noticeable in the coronary vessels ------------------------------Kawasaki disease Serial echocardiography must be performed at the time of diagnosis of Kawasaki disease in order to rule out coronary artery aneurysms. It also should be performed 1-2 week and 5-6 weeks after onset. ------------------------------Mortality associated with Kawasaki disease is most likely related to coronary artery aneurysm. Kawasaki disease symptoms include ------------------------------- Conjunctivitis - Rash - Erythema of hands and soles of feet - Adenopathy (cervical) - Strawberry tongue Cremasteric reflex is checked in infants to assess for ------------------------------Retractile testicles. The leading cause of death in infants under the age of 1 ------------------------------Sudden infant death syndrome Children and teens with depression commonly present with irritability. ------------------------ ------The ductus arteriosus closes within the first 1-2 days of birth. Having a boy sit cross legged and blow into a balloon should stimulate ---------------------- --------Cremasteric reflex Testicles fully descend by what age ------------------------------6 months Moro reflux is also known as ------------------------------Startle reflex Clinical evidence supports medication treatment for depression should be continued for a minimum of 1 year. ------------------------------ACP guidelines recommend altering therapy if no improvement in 6-8 weeks. Osgood-Schlatter disease ------------------------------A condition that causes pain and swelling below the knee joint Growing pains occur at ------------------------------Nighttime Knee locking is a classic complaint of ------------------------------A meniscal tear Septic arthritis is ------------------------------An infection of the synovial fluid caused by staph aureus Paget's disease is characterized by ------------------------------An abnormal bone destruction or growth of bone. It is treated with bisphosphonates In cervical radiculopathy there is nerve root compression that results in burning pain in the neck and one arm. ------------------------------Cervical myopathy there is pain and bilateral weakness in both upper and lower extremities. The Lachman's test is used to assess ------------------------------ACL tear Point tenderness over the posterior malleolus with an inability to bear weigh after 4 or more steps is a sign of ------------------------------An ankle fracture Localized tenderness over the ankle joint is a sign of ------------------------------A ligamentous injury The varus stress test assesses for ------------------------------A lateral meni cus tear The valgus stress test assesses for ------------------------------A medial meniscus tear Having the patient place hand behind back and touch shoulder blade elicits internal rotation. ------------------------------That was very interesting. Shoulder extension is tested by ------------------------------Asking the patient to move their arm behind themselves Shoulder flexion is tested by ------------------------------Asking the patient to move their arm in front of their body The straight leg raise test is used to ------------------------------Evaluate for sciatica Tinel's sign is ------------------------------When the NP taps over the median nerve and is positive for carpal tunnel if tenderness is felt Phalen's sign is ------------------------------When the patient holds their wrist together to form right angles for 60 seconds and is positive for carpal tunnel if tenderness is felt Finkelstein test is done by ------------------------------Having the patient place their thumb in the palm and then bend the wrist toward the little finger. Positive for Quervain's tenosynovitis if pain is felt on the thumb side Inability to extend the knee is a sign of a ------------------------------Partial or complete patellar tendon tear Sacral nerve 1 control the ankle DTRs ------------------------------Ankle DTRs Lumbar nerves 2,3, and 4 control the ------------------------------Knee DTRs Cervical nerves 5 and 6 control the ------------------------------Biceps DTRs Cervical nerves 6 and 7 control the ------------------------------Triceps DTRs Lumbar 5 and Sacral 1 control ------------------------------Plantar reflexes Signs and symptoms of carpal tunnel syndrome include ------------------------------- Dropping objects - Unable to twist off lids - Aching wrist/forearm - Numbness of the first 3 digits Nick stiffness and resistance when flexing the neck forward indicates ------------------------ ------Muscle rigidity (tell me about it!) OMGSH! This is the last card!!! You don't have to memorize this one! ------------------------ ------My Super Amazing Super Intelligent Super Sexy Wife! You've got this! You are so smart, you're going to ace this exam!